Antenatale toediening van glucocorticosteroïden bij dreigende vroeggeboorte

- The administration of glucocorticosteroids to pregnant women results in a striking decrease of neonatal morbidity and mortality in premature infants.

- A single course of steroids – 24 mg of betamethasone or dexamethasone, given in 2 to 4 doses – does not seem to result in long-term adverse effects, although relatively few follow-up studies have been carried out.

- However, betamethasone causes a temporary – yet considerable – reduction in fetal heart rate variation as well as in fetal breathing and body movements. Familiarity with this phenomenon prevents unnecessary medical intervention (because of presumed fetal distress).

- Although the use of glucocorticosteroids was for a long time limited due to concerns about negative adverse effects, it has recently become common practice to repeat the courses weekly in the case of a persistent risk of premature birth.

- However, in contrast to the single course, there is no evidence that repeating a corticosteroid course improves the effectiveness of the treatment. (Long-term) adverse effects are probably dose dependent. The repetition of corticosteroids courses must therefore be advised against for the time being, unless this takes place within the framework of a randomised study.